Shen C, Chen H, Yin R, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J
Neoplasma. 2015;62(4):610-7. doi: 10.4149/neo_2015_073.
Rectal gastrointestinal stromal tumors (GISTs) are rare, and limited information is available concerning their management and long-term outcomes. We retrospectively evaluated the clinicopathological characteristics, surgical management, and long-term outcomes of rectal GISTs from a single institution.All surgically treated patients with rectal GISTS at the Department of General Surgery, West China Hospital, Sichuan University were identified between January 2005 and May 2014. The overall survival (OS) and disease-free survival (DFS) were assessed by the Kaplan-Meier method. Forty-five patients with rectal GISTs (33 males and 12 females) were identified. Patients presented with rectal bleeding (n = 13; 28.9%) and altered bowel habits (n = 11; 24.4%). The cohort study of 45 patients included 4 very low-risk, 10 low-risk, 1 intermediate-risk, and 30 high-risk patients. A total of 21, 13, and 11 patients underwent local resection (Group 1), abdominoperineal resection (Group 2), and super-low or low anterior resection (Group 3), respectively. Group 1 had a smaller tumor sizes and shorter distances from the anal verge compared with the other groups (P < 0.05). The one-, three-, and five-year DFS rates for the entire cohort study were 90.4%, 69.3%, and 57.0%, respectively. High National Institutes of Health (NIH) risk categories (HR = 1.62) were associated with low DFS rates (P = 0.035). The DFS was significantly improved by imatinib mesylate (IM) adjuvant therapy in the high-risk subgroup (P = 0.001). The type of surgery should be chosen based on the location and size of the rectal GISTs. Adjuvant IM therapy was associated with improved DFS in patients with high-risk tumors, and classification was strongly associated with the patient outcome.
直肠胃肠道间质瘤（GISTs）较为罕见，关于其治疗及长期预后的信息有限。我们回顾性评估了来自单一机构的直肠GISTs的临床病理特征、手术治疗及长期预后。
确定了2005年1月至2014年5月期间在四川大学华西医院普通外科接受手术治疗的所有直肠GISTs患者。采用Kaplan-Meier法评估总生存期（OS）和无病生存期（DFS）。
共确定了45例直肠GISTs患者（男性33例，女性12例）。患者表现为直肠出血（n = 13；28.9%）和排便习惯改变（n = 11；24.4%）。对45例患者的队列研究包括4例极低风险、10例低风险、1例中度风险和30例高风险患者。分别有21例、13例和11例患者接受了局部切除（第1组）、腹会阴联合切除术（第2组）和超低位或低位前切除术（第3组）。与其他组相比，第1组的肿瘤尺寸较小，距肛缘距离较短（P < 0.05）。整个队列研究的1年、3年和5年DFS率分别为90.4%、69.3%和57.0%。高美国国立卫生研究院（NIH）风险类别（HR = 1.62）与低DFS率相关（P = 0.035）。在高风险亚组中，甲磺酸伊马替尼（IM）辅助治疗显著改善了DFS（P = 0.001）。应根据直肠GISTs的位置和大小选择手术类型。辅助IM治疗与高风险肿瘤患者DFS的改善相关，且分类与患者预后密切相关。
